Discharge And Home Healthcare Guidelines

PATIENT TEACHING. Teach the patient the care related to the abdominal incision and any perineal wounds. Give instructions about when to notify the physician (if the wound separates or if any redness, bleeding, purulent drainage, unusual odor, or excessive pain is present). Advise the patient not to perform any heavy lifting (>10 lbs), pushing, or pulling for 6 weeks after surgery. If the patient has a perineal incision, instruct her or him not to sit for long periods of time and to use a soft or "waffle" pillow rather than a rubber ring whenever in the sitting position.

Teach the patient colostomy care and colostomy irrigation.

Give the following instructions for care of skin in the external radiation field: Tell the patient to wash the skin gently with mild soap, rinse with warm water, and pat the skin dry each day; not to wash off the dark ink marking that outlines the radiation field; to avoid applying any lotions, perfumes, deodorants, and powder to the treatment area; to wear nonrestrictive soft cotton clothing directly over the treatment area; and to protect skin from sunlight and extreme cold. Explain the purpose, action, dosage, and side effects of all medications prescribed by the physician.

FOLLOW-UP. Stress the need to maintain a schedule for follow-up visits recommended by the physician. Encourage patients with early-stage disease and complete healing of the bowel to eat a diet consisting of a low-fat and high-fiber content with cruciferous vegetables (Brussels sprouts, cauliflower, broccoli, cabbage).

Most colorectal tumors grow undetected as symptoms slowly develop. Survival rates are best when the disease is discovered in the early stages and when the patient is asymptomatic. Unfortunately, 50% of patients have positive lymph node involvement at the time of diagnosis. Participation in procedures for the early detection of colorectal cancer needs to be encouraged.

Suggest follow-up involvement with community resources such as the United Ostomy Association and the American Cancer Society.

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